阴茎部整形术的应用解剖学研究

目的 探讨阴茎及其与邻近组织的解剖关系，为阴茎部整形术提供解剖学基础。方法 对30具(左右60侧)成年男性尸体的阴茎和会阴部进行解剖学观察，对阴茎各部的长度，漏斗韧带和悬韧带与阴茎根关系，阴茎海绵体脚与阴茎血管的关系进行观察和测量。结果 所测成人阴茎体长度为8．13cm；阴茎根长度为7．67cm，海绵体脚长度为5.96～5.98cm。漏斗韧带附着于阴茎根前部，阴茎浅筋膜两侧，并向下延伸为阴囊纵隔，参与组成阴囊和阴茎的悬吊结构；悬韧带附着于阴茎深筋膜背侧，后部增厚与耻骨弓状韧带紧密连结，参与尿道悬吊结构。在阴茎根部与阴茎海绵体脚部之间，有一段既无韧带附着又无骨性附着的海绵体，阴茎背动脉和神经在此处从腹侧转向背侧，阴茎背深静脉由此处穿过尿生殖膈注入盆腔内静脉丛。阴茎深动脉在海绵体脚骨性附着中部进入阴茎。结论 本组30例阴茎体长度的分区测量，阴茎悬吊结构的再认识及海绵体脚与阴茎深动脉的解剖关系对阴茎部整形手术具有重要意义。     

阴茎悬吊系统在隐匿性阴茎矫治手术中的解剖应用(附56例报道)

目的探讨研究阴茎悬吊系统作为解剖标记在隐匿性阴茎矫治手术中的临床应用。方法回顾性分析2019年7月至2021年12月在本院经手术治疗的56例隐匿性阴茎患者的临床资料, 所有患者均实施隐匿性阴茎矫治手术, 术中利用阴茎悬吊系统作为解剖标记, 将阴茎皮肤逆向脱套至阴茎体根部背侧正中的阴茎悬韧带及呈"U"型包绕阴茎根部的袢状韧带, 切断阴茎悬韧带浅部, 从而充分释放阴茎海绵体, 然后以袢状韧带作为水平标记线, 于阴茎体根部1点和11点处将阴茎白膜缝合固定于耻骨联合前部皮肤的真皮层, 以重建阴茎-腹壁角进一步改善阴茎显露效果, 术中注意保护袢状韧带、阴茎悬韧带深部及耻骨弓状韧带, 保障阴茎术后勃起的稳定性和勃起角度。结果所有患者均顺利完成手术, 手术时间为(78.0±6.5)min, 术前疲软状态时的阴茎长度为(2.2±0.6)cm, 术后1个月复查疲软状态时的阴茎长度为(5.6±0.4)cm, 患者术后阴茎长度较术前增加(P<0.05), 所有患者均对术后阴茎外观显露非常满意, 阴茎勃起时与腹壁夹角均<90 °, 且可稳定维持勃起角度和方向;对48例已有性生活的成年患者分别于术前...     

改良阴茎延长术的解剖学研究和临床应用

目的 对阴茎发育不良症患者,采用阴茎海绵体延伸术和脂肪瓣转移术充分延长短小的阴茎.方法 通过对男性会阴部结构的解剖学研究,了解阴茎悬韧带的厚度、阴茎脚剥离长度与稳定性的关系;通过离断阴茎浅、深悬韧带,并分离部分海绵体脚,使原固定于耻骨下支的阴茎海绵体充分分离,以使阴茎更为延伸;用含血运的脂肪瓣填塞耻骨前间隙,保证术后远期阴茎的有效长度.结果 2001至2009年采用上述方法行阴茎延长术205例,术前阴茎常态下平均长度4.26cm,勃起时平均长度8.13 cm,术后阴茎常态下平均长度8.63 cm,勃起时平均长度12.11 cm.结论 采用本方法可在不影响阴茎勃起时稳定性的前提下,使阴茎海绵体比以往的阴茎延长术多延伸1～2 cm,使之更加满足患者生理和心理上的需求.     

基于MRI的阴茎深悬韧带及毗邻结构的三维重建

目的 建立阴茎深悬韧带三维图像,以探索对患者个体的阴茎深悬韧带的立体化多角度的观察方法.方法 以阴茎短小欲行阴茎延长术者作为受试者,于术前行磁共振成像(MRI)检查并将结果导入三维重建软件(MIMICS 10.0)中,重建阴茎深悬韧带、阴茎海绵体和耻骨联合等结构,并对其进行观察.结果 薄层MRI图像上可较为清晰的显示耻骨联合、阴茎海绵体、尿道海绵体,耻骨联合前下方和阴茎海绵体之间可见斑片状分布的阴茎深悬韧带.通过MIMICS 10.0可以对上述结构进行三维重建,对阴茎深悬韧带起止,以及其与阴茎海绵体的夹角、在阴茎海绵体上附着的范围等进行精确的描述.结论 基于MRI的阴茎深悬韧带及毗邻结构的三维重建,可对患者的阴茎深悬韧带进行动态、立体化多角度的观察,且利用重建后的图像还可为阴茎延长手术前判断阴茎海绵体延长长度,以及阴茎深悬韧带切除深度,提供一定的理论依据.     

阴茎及其毗邻组织三维虚拟模型的建立

目的 探讨基于磁共振图像建立阴茎及其毗邻结构三维虚拟模型的可行性,为个性化阴茎整复手术仿真系统的开发提供建模方法.方法 采用适宜的参数获得磁共振图像,在Amira软件中运用面绘制方法对正常成人阴茎及其毗邻组织进行三维重建和立体显示.结果 3.0 mm层厚的快速自旋回波T2加权磁共振图像,可清晰显示阴茎及周围解剖结构且轮廓分明,以此建立的模型可清晰显示阴茎海绵体、阴茎悬韧带等结构的形态和相互位置关系,可见阴茎悬韧带呈纵行附着于耻骨联合与阴茎海绵体背侧之间,阴茎海绵体脚附着于耻骨下支.结论 基于磁共振图像建立阴茎及其毗邻组织三维模型是一种可行的方法,建立的模型可用于开发个性化阴茎整复手术仿真系统.     

正常男性的阴茎延长术

目的：探讨应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法对正常男性阴茎延长的效果。方法：总结8年来收集的130例阴茎短小患者的资料,年龄16～53岁,平均年龄24岁,均采用同样的阴茎延长术式。结果：130例全部成功,仅1例发生切口脂肪液化,经定期换药处理后愈合,术后静态长度平均延长2.5～4cm,勃起后长度平均延长2～3.5cm。术后随访6～12个月,患者对阴茎外形、长度均满意,其中,有性生活的患者对术后性生活质量满意度均有不同程度的提高。结论：应用耻骨上倒U形切口、阴茎背侧浅悬韧带及部分深悬韧带切断的方法行阴茎延长术,具有手术成功率高、术后并发症少、术后瘢痕隐蔽及效果满意的优点。     

阴茎延长术的解剖与临床应用

目的探讨成人阴茎延长术的可行性和安全性。方法在20具正常男性成年人尸体阴茎延长解剖学观测的基础上,选择46例阴茎短小（2.8±1.2）cm（1.6～3.5 cm）患者,在阴茎根部设计＂N＂形切口,左、右径3.0～4.5 cm,保留皮瓣足够厚度和良好血运,从皮肤到阴茎浅韧带的厚度3.0～5.0 cm,直视或指感下完全切断阴茎浅韧带,将深韧带切断1/3,切口留置皮条引流。结果尸体解剖学观测,阴茎浅韧带在阴茎根部的厚度为（0.4±0.1）cm（0.2～0.7 cm）,宽度（3.1±0.9）cm（2.1～5.0 cm）。阴茎深韧带厚度为（2.5±1.0）cm（2.0～3.1 cm）,宽度（0.5±0.1）cm（0.4～0.6 cm）。46例术后测量阴茎自然静态下长度（4.6±1.5）cm（3.5～6.0 cm）,较手术前延长（2.5±0.7）cm（1.9～3.5 cm）,术后与术前比较差异有统计学意义（t=4.228,P=0.000）。3例术后阴茎水肿用1∶5000呋喃西林液浸泡3个月后消退。42例（91.3%）随访8个月～15年,平均6年2个月,〉5年31例,患者自信心增加、自觉性生活满意占85.7%（36/42）,另6例（14.3%）感到延长长度不够,仍不满意。结论切断阴茎浅韧带和部分深韧带行阴茎延长术安全有效,术后阴茎皮下顽固水肿与阴茎背浅静脉及淋巴管损伤有密切关系。     

悬韧带松解阴茎延长术后延长长度预测模型的建立和验证

目的 研究悬韧带松解阴茎延长术术后延长长度的个体化预测方法.方法 选取第三军医大学第一附属医院整形美容科1988年10月至2011年4月行悬韧带松解阴茎延长术的先天性阴茎发育不良病例322例,随机分为建模组(200例)与验证组(122例),将建模组手术前、后的常态与勃起状态阴茎长度等指标进行相关性或线性回归分析,并推导预测公式,通过建模组与验证组中预测结果与实际结果的一致性来评价预测效果.结果 患者术后常态与勃起状态的延长长度以及术前、术后阴茎由常态到勃起状态的伸长率存在显著的相关性(相关系数分别为0.921、0.803,P＜0.01),由此可推导出延长长度的预测公式,通过对建模组与验证组的数据进行检验,预测误差在±1.5 cm以内时其有效预测率分别为84.5％(169/200)和87.7％(107/122).结论 该预测公式可用于悬韧带松解阴茎延长术后延长长度的初步个体化预测.     

真皮脂肪复合组织条移植在阴茎增粗延长术中的应用

目的 探讨应用真皮脂肪复合组织条游离移植行阴茎增粗延长术的方法及临床疗效.方法 2004年5月至2010年12月,应用自体真皮脂肪组织条游离移植加阴茎根部切口阴茎延长术,对24例患者行阴茎增粗延长.采用阴茎根部切口,切断阴茎浅悬韧带及部分深悬韧带进行阴茎延长,同时在阴茎深筋膜与海绵体白膜间游离移植长6.0～9.5 cm,宽1.2～1.5 cm,厚度0.6～0.8 cm真皮脂肪复合组织条,自耻骨前区腔隙直至阴茎冠状沟,以增粗阴茎.结果 24例中23例一期愈合,1例发生切口脂肪液化,换药后愈合.阴茎常态及勃起后形态良好,勃起时延长长度为2.5 ～4.8 cm,平均3.2 cm;阴茎周径延长长度为1.8～3.0 cm,平均2.4 cm.本组18例获得3个月至5年的随访,所有患者对术后阴茎形态满意,对性生活质量满意度高,未见手术并发症.结论 真皮脂肪复合组织条移植加阴茎悬韧带切断术是一种较好的阴茎增粗延长术式,手术安全,效果肯定.     

肘管综合征的应用解剖学研究

目的 研究肘管综合征中尺神经的卡压因素,为临床手术提供解剖学依据.方法 采用解剖学方法对16具(32侧)成人尸体上肢标本进行解剖,观测造成尺神经卡压的Struthers弓形组织、内侧肌间隔和肘管,测量肘管内尺神经的面积、肘管的面积和肘管的长度,测量弓状韧带的长、宽和厚度.观测尺神经的营养血管及伴行长度,观测尺神经的尺侧腕屈肌肌支.结果 32侧上肢标本中12侧存在腱性Struthers弓形组织,10侧有肌性Struthers弓形组织,存在率为68.8%.尺神经在内上髁上方[(11.02±1.16)cm,小x±s.下同]处穿内侧肌间隔,尺神经肘管内面积与肘管面积之比为1:3.86,肘管长度为(1.96±0.18)cm.尺神经伴行血管有尺侧上副动脉和尺侧返动脉后支,尺神经在内上髁下方1cm左右发出尺侧腕屈肌肌支.结论 尺神经在肘管处最容易受压,手术治疗肘管综合征时向上的切口长度约为11.02cm,同时切除Struthers弓形组织和内侧肌间隔;尺神经前置手术时,注意保留与神经伴行的尺侧返动脉后支.     

Penile suspensory ligament division for penile augmentation: indications and results

OBJECTIVE: This study assessed the management of patients requesting penile length enhancement by division of the penile suspensory ligament. METHODS: From September 1998 to January 2005, 42 patients with a variety of etiologies were included; all underwent division of the penile suspensory ligament. The outcome was assessed objectively based on increase in flaccid stretched penile length (SPL) and subjectively using the rates of patient satisfaction. RESULTS: The mean increase in SPL was 1.3+/-0.9 cm (range, -1 to +3 cm), with the addition of a silicone spacer placed between the pubis and penis giving a better outcome (p<0.05). The overall patient satisfaction rate was 35% but lower in the group with penile dysmorphic disorder at 27%. CONCLUSION: Division of the penile suspensory ligament or other augmentation techniques may increase penile length but usually not to a degree that satisfies the patient. Men with penile dysmorphic disorder often have unrealistic expectations regarding the outcome of surgical intervention and should be encouraged to seek psychological help primarily, with surgery reserved as the last resort.     

应用阴囊肉膜平滑肌肌皮瓣修复阴茎延长术中的阴茎创面

目的 提供理想的阴茎延长术中阴茎创面的修复组织。方法 在阴茎1阴阜区皮肤交界处切开、切断阴茎浅悬韧带和部分阴茎深悬韧带行阴茎延长术后，应用以阴囊前动、静脉为血管蒂的阴囊膜平滑肌肌皮瓣（下简称阴囊皮瓣）转移修复在阴茎根部所形成的创面。结果 1996年以来共应用于16例患者，阴茎平均延长4－4．5cm，阴囊皮瓣全部成活，阴茎形态满意，阴囊无明显变形。结论 阴囊皮瓣血运丰富，薄而无皮下脂肪，有伸缩性，是阴茎延长手术中阴茎皮肤缺损较好的修复方法之一。     

Levator ani muscle: new physioanatomical aspects and role in the micturition mechanism

The anatomy of the levator ani muscle was studied in relation to the urinary bladder. The study was performed on 23 cadavers by dissection and microscopic examination. The levator ani is funnel-shaped and consists of a transverse portion called the levator plate and a vertical portion called the suspensory sling. The levator plate is a cone and consists of two “lateral masses” and two “crura,” with the levator hiatus occupying its anterior part. Three crural patterns could be identified: classic, crural overlap, and crural scissors. The levator crura are connected to the intrahiatal organs by the hiatal ligament; the pubovesical ligament constitutes the anterior part of this ligament. The suspensory sling forms a vertical cuff around the intrahiatal organs, from which it is separated by a “tunnel septum.” Its urethral portion ends in multiple fibrous septa, which penetrate the striated urethral sphincter. The levator ani plays an important role in bladder-neck fixation provided by the suspensory sling and hiatal ligament. Levator ani and hiatal ligament subluxation leads to ptosis of the urinary bladder. Furthermore, the present study demonstrates that the urethra is located in the infralevator compartment and is thus protected from the effect of intraabdominal pressure. A chronic increase in intraabdominal pressure leads to levator subluxation and sagging and to urethral exposure to intraabdominal pressure, which seems to interfere with the micturition mechanism. The infralevator location of the urethra might have a bearing on the pathogenesis and treatment of stress urinary incontinence.     

连续Z形皮瓣在阴茎延长术中的应用

目的:提供一种阴茎延长术中创面修复方法,即连续Z形皮瓣。方法:5例患者年龄为16～34(22.4±7.2)岁,有3例有既往手术史,分别为尿道下裂行尿道成形术、"包茎"行包皮环切术、隐匿型阴茎行阴茎松解术。采用连续Z形皮瓣行阴茎延长术,解剖并切断阴茎浅悬韧带和部分深悬韧带,皮瓣依次交叉对位,无张力下缝合。根据创面渗出液多少决定是否放置引流。插尿管1～2d,阴茎适当加压包扎,术后8～10d拆线。结果:该5例患者术前阴茎勃起长度为4.0～5.8(4.8±0.8)cm,术后为7.8～9.2(8.4±0.6)cm,有2个中学生术后性格变得开朗,自信心明显增强。切口均一期愈合,术后电话随访12～48(22.8±14.9)个月,无阴茎回缩,患者及家属基本满意。结论:对于伴有外生殖器畸形、既往手术后瘢痕、包皮环切手术后的患者,连续Z形切口与传统的倒V形、M形、Z形切口相比,能获得更长的延长距离,解决了皮瓣过紧甚至无法覆盖创面的难题,减少了术后并发症的发生。     

Hidden penis: a rare case of delayed complication after a pelvic blunt trauma

Penile dislocation following a traumatic pubic bone fracture is a very rare condition. Only a few cases are reported in the literature and the presentation mechanism is still not completely understood. The impact energy on the pelvis usually causes a displaced fracture with concomitant withdrawal of the pubic bone. The retraction of the pubic bone pulls the penis by its suspensory ligament leading to penile dislocation. We describe a rare case of a “hidden” penis 2 months after a blunt pelvic trauma following a motor vehicle accident. Clinical examination revealed a retracted penile skin. The penis was not visible, neither palpable in the expected position. Micturition took place by dripping urine from the opening of the prepubic skin where urine got trapped in the surrounding skin. He also complained of not having erections. A magnetic resonance imaging that showed invaginated penis, located in the anterior pelvic wall, adjacent to the right inguinal canal. Surgical repair was performed trough an inverted “V” suprapubic incision that allowed exploring the pubic area. The degloved penile shaft was identified and isolated from fibrotic adhesions to the surrounding tissue. The invaginated penile skin that was thin and retracted. The point of fixation was located deeply in the right pubic area where the subcutaneous tissue and skin were firmly attached to a spike of the fractured pubic bone. This adhesion was sharply resected and the penis and its skin were restored in their anatomical position. The suspensory ligament was partially detached. Erection was simulated using saline solution injection into the corpora cavernosa to exclude penile curvature. Postoperative course was uneventful. One year after surgery, the penis had a normal appearance without retraction and sexual function was completely restored. Our case pointed out the importance of genitalia evaluation by practitioners involved in the care of pelvic trauma patients.     

阴茎型尿道上裂的解剖学修复

目的 探讨阴茎型尿道上裂的病理解剖特点和解剖学修复方法.方法 以尿道上裂患者局部尿道板成形缺损段尿道,切断阴茎浅悬韧带松解阴茎背侧挛缩,使得阴茎及尿道海绵体复位,从而完成尿道修复.结果 2004年6月至2010年12月,于临床应用26例,术后18例获得随访,时间为6个月至5年,10例手术一次成功,排尿通畅,控尿能力良好,阴茎背侧弯曲消失,尿道外口位于阴茎头端,效果良好;另8例有不同程度的尿失禁,二次手术进行尿道紧缩后消失.结论 将阴茎型尿道上裂的病理解剖结构恢复其正常的解剖学关系,能够达到外形及功能的良好修复.     

阴茎深层静脉的应用解剖学研究

目的:探讨阴茎深层静脉系统走行与分布及其在静脉性ED相关手术中的应用价值。方法:对死亡原因、生前所患疾病、勃起状况和确切年龄不明的28例成年男性尸体阴茎深层静脉系统进行解剖,记录海绵体静脉和阴茎脚静脉的数目、位置及其与周围重要结构的关系。结果:海绵体静脉起源于海绵体固定段背侧中间沟内,在中间沟形成彼此交通的静脉丛,向近端行走于背深静脉深部,向近端分别进入两侧阴部内静脉。所有标本均可见海绵体静脉与前列腺周围静脉丛之间有交通支。阴茎脚静脉起源于阴茎脚背侧、内侧和腹侧,向内侧和下方进入同侧阴部内静脉。本组28例标本,56侧,共250支脚静脉。其中42侧(75.0%)有76支脚静脉走行于阴部内动脉、海绵体动脉、阴茎背动脉内侧。结论:阴茎深层静脉结构复杂,与中层静脉有广泛交通支存在,与周围重要结构关系密切,静脉手术很难完全结扎所有深层静脉,并且容易损伤海绵体动脉和神经。     

Penile lengthening for traumatic penile amputation due to ritual circumcision: a case report

Some tribes in South Africa still practice ritual circumcision in adolescent boys. A traditional healer performs the procedure and, not uncommonly, amputation occurs. The authors present a case of a 20-year-old man who sustained a midshaft penile amputation as a result of a ritual circumcision. Treatment was with a modified penile-lengthening technique that incorporates gracilis muscle transposition to fill the dead space created after detaching the penile suspensory ligament. This may help prevent retraction. Almost 3 cm of lengthening was obtained. This is a useful method of treatment for penile amputation.     

Suspensory ligament release combined with acellular dermal matrix filler in infrapubic space: A new method for penile length augmentation

Until now, no reliable method is recognised in treating buried penis. This study explored a new method of penile length augmentation using acellular dermal matrix filler in infrapubic space combined with liposuction and penile suspensory release. Patients with “small‐sized penis” received penile length augmentation procedure including suprapubic liposuction, penile suspensory ligament release and insertion of folded acellular dermal matrix between corpora cavernosa and pubis symphysis. Their penile length from tip to skin was measured pre‐operatively and post‐operatively. The post‐operative complications and patients' satisfaction were also recorded. Fifteen adult male patients were included with the mean age of 33.2 ± 4.6 years old and BMI of 28.9 ± 5.3 kg/m². The average amount of liposuction was 430 ± 90.0 ml. The average penile length measured pre‐operatively and post‐operatively (on table and 3 months afterwards) was 3.0 ± 1.3 cm, 7.3 ± 2.1 cm and 5.4 ± 1.8 cm. The penile length has significantly increased by 4.3 ± 1.6 cm (on table) and 2.4 ± 0.8 cm (3 months post‐operatively; p < 0.05). The post‐operative complications included oedema of penis, ecchymosis of lower abdomen and poor wound healing. No patient was dissatisfied with the appearance and function. The new method using acellular dermal matrix combined with liposuction and penile suspensory ligament release is safe and effective. The method could be applied to selected patients with buried penis.